Therapeutic Agenda Research Articles

마약류 치료기술 국내 도입 우선순위

Objectives: To determine Korean national priority for research and development planning for drug abuse and substance use disorder treatment. Methods: A Delphi survey methodology was employed, involving 19 experts in the field of addiction. Their potential priorities were assessed based on the size of the problem, urgency, effectiveness, budget size, and feasibility of research execution. Results: After three rounds, the expert consensus was reached for 13 research plans of universal therapeutic agenda and 7 plans for specific drugs. These included developing guidelines for children and adolescents on substance use, a community-based long-term management program, and the development of intervention programs and clinical guidelines for stimulant, cannabis, and opioid use disorders. However, consensus was not reached for research on therapeutic options such as digital therapeutics. Conclusion: This study highlights priority areas for systematic and effective development of treatment programs and research agenda against illicit use of drugs. By integrating insights from multidisciplinary experts, a comprehensive research and development blueprint is proposed to address drug use, which is on the rise and threatening public health and social security in the Republic of Korea.

Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country.

Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond-Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0-2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.

Sisyphus on horseback: Landscape allegory in the postwar Western

This article locates a psychological mobilization of natural settings in the post-war Westerns Duel in the Sun, Lonely Are the Brave, and Man in the Wilderness, which I refer to as ‘Sisyphean’ landscape allegory. This narrative of inner conflict is not only expressed through an inhospitable terrain per se, but also through the protagonist’s physical attempts to navigate and/or overcome it as a primary obstacle. I argue that the existential sense of futility these films invoke through their Sisyphean sequences serves to corroborate audience angst rather than to assuage it. At the same time, the larger therapeutic agenda of these films for American audiences varied according to their cultural milieu.

Tackling racism in sports psychiatry

Abstract: Racism is embedded in society and, therefore, in sports. This paper summarizes the long history of racism directed at Black athletes in the United States, the various ways that racism is manifest in sports, and the psychological impact of racism on individual athletes. Suggestions for addressing racism in the clinical setting as well as in the athletic environment are presented, along with several clinical vignettes. Because racism affects everyone, it is suggested that clinicians advance their self-awareness and knowledge of the problem, and several avenues for doing so are presented. It is suggested, in addition, that the topic of race be included in the therapeutic agenda while keeping in mind that it is the patient’s prerogative to determine when race is relevant and when it is not.

Embodied Cognition in Edgar Allan Poe

Stephanie Kinzinger, “Embodied Cognition in Edgar Allan Poe: Eureka’s Cosmology, Dupin’s Intuition” (pp. 124–144) This essay argues that Edgar Allan Poe’s Eureka (1848) anticipates contemporary cognitive science’s theories of embodied cognition, particularly the notion that individuals’ minds and bodies are inextricable from their environments. Eureka’s cosmology of environmental entanglement, furthermore, surprisingly elucidates detective Auguste Dupin’s uncanny “intuitive” knowledge, as imbrication with cosmic processes affords limited, temporary access to extrapersonal knowledge. Dupin, I contend, capitalizes on the interconnectedness of mind and body, self and environment to attune himself to others, and in the process enacts a precursive version of “social mirroring.” However, along with the enabling possibilities inherent in such interconnectedness, Poe also illuminates its ontological dangers, as Dupin when intuiting transforms into a semi-abstracted self and loses some of his discrete individuality—without going as far as Poe’s mesmerists, whose complete opening to the universe’s extrapersonal forces leads to their annihilation as individual beings. I argue that such dangers shadow not only nineteenth-century transcendentalism’s cosmic egotism but also twenty-first-century cognitive science’s therapeutic agenda.

“We are a unique breed”: strategies to enhance physical activity participation for preschool-aged children born extremely preterm, a mixed-methods study

Purpose Preschool-aged children (three to five years old) born preterm participate in less physical activity (PA) than term-born children. Circus activities (a type of recreational PA) are a potential avenue to increase PA rates, but further insight into how to tailor these to address the participation gap is needed. This study investigated barriers and facilitators informing participation in recreational PA for preschool-aged children born extremely preterm and explored strategies to enhance participation in circus activities. Materials and methods Sequential mixed-methods study utilizing surveys (n = 217), interviews (n = 43), and a focus group (n = 6) with key stakeholder groups (parents, coaches, and clinicians). Qualitative data (Framework Method) and quantitative data (descriptive statistics) were mixed during preliminary and final analyses. Results Five themes were developed from the mixed data: the crucial role of the coach and the need for specific training, the therapeutic role of PA and promoting outcomes beyond the physical, the impact of communication and class planning, consideration of convenience and cost, and finally, the role of clinicians. Conclusions Barriers, facilitators, and strategies were identified which may be used to modify or co-design circus-based PA interventions to enhance participation and improve rates of PA for preschool-aged children born extremely preterm. IMPLICATIONS FOR REHABILITATION Families consider recreational physical activities to be part of the therapeutic agenda for their preschool-aged children born extremely preterm. Key stakeholders feel that recreational physical activity should target outcomes beyond the physical. Coach attributes and capability impact participation of children born preterm and their families, and may be enhanced with specific training. Clinicians should be engaged in design of recreational physical activities for children born preterm.

Therapeutic Notepad: A Path to Happiness and Well-Being

Human beings are curious, intrinsically motivated and often look for sensations based on goals and plans to overcome the difficulties and challenges that arise towards happiness, wellbeing, and personal growth. The present study aims to understand the usefulness and practicality of a therapeutic notepad, which is composed of inspiring quotes and tasks underlying happiness and well-being. 111 young people and adults, aged between 18 and 58 years (M= 21.81; SD= 5.34) participated in this study, being 47.3% male individuals and 52.7% female individuals. First, a sociodemographic questionnaire was applied to collect personal data; then was administered the Psychological Well-Being Manifestations Scale (Échelle de Mesure des Manifestations du Bien-Être Psychologique) which translates into a response instrument five-point likert type with five subscales including happiness. Finally, a semistructured interview was applied to understand the functionality of the therapeutic agenda. The results showed, both qualitatively and quantitatively, that the notepad can be assumed as an agent that promotes happiness and well-being as well as reducing the negative mood of individuals. This study focuses on the importance of well-being and happiness in the daily lives of individuals. This is an important contribution, as it allows to gauge that the notepad leads to positive and motivating results when applied.
 
 Received: 11 December 2021 / Accepted: 21 February 2022 / Published: 5 May 2022

Solution-Focused Therapy through the Lens of Discourse Analysis

This paper introduces discourse analysis in psychotherapy research as it is performed namely within the context of solution-focused brief therapy. It has the character of an overview study with a closer emphasis on several examples from the solution-focused context in relation to Discourse Analysis in individual, couple, or family therapy. In this text, the authors introduce examples of contemporary research that deal with the role of formulations in psychotherapy and counseling; the therapist pursuing a therapeutic agenda; and the process of change, as well as the broader psychotherapeutic discourse.

Assessment and treatment planning for schizotypal personality disorder: A metacognitively oriented point of view.

The aim of this study was to pilot test a novel assessment and treatment plan for patients with a schizotypal personality disorder by integrating the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) alternative model of personality disorders, metacognitively oriented psychotherapies, and recovery approaches. I recruited 12 patients diagnosed with schizotypal personality disorder. I report results from the global assessment including measures on symptoms, maladaptive traits, Big Five personality traits, schizophrenia proneness, and metacognition. I also describe how I planned treatment to promote an individualized understanding of a person's agenda and recovery. The treatment plans were also evaluated through in-depth qualitative interviews at the end of the intervention. Interviews were analyzed through a phenomenological framework and a computer-aided qualitative analysis software. Assessment results and qualitative interviews highlight the importance of a multilevel, progressive treatment plan aimed at considering the personality functioning from a recovery-oriented, nonpathologizing approach. On 1 hand, an assessment that focuses on both healthy and maladaptive traits fosters a progressive redefinition of the therapeutic agenda. On the other hand, a constant and recursive evaluation of metacognition and personality traits offers a treatment strategy that supports my core assumption that recovery from schizotypal personality disorder is possible. A twofold focus on personality traits and metacognition seems to represent a viable strategy for treating patients with schizotypal personality disorder. A metacognitively oriented rehabilitation may be a flexible, personalized and effective approach toward recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Very early systemic sclerosis.

The early diagnosis of systemic sclerosis (SSc) can be very difficult, when most of the typical signs and symptoms are absent. For this reason, the approach to SSc has changed during the last decades because the importance of an early diagnosis and treatment has been widely understood. "Very early SSc" is identified as a condition characterized by Raynaud's phenomenon, puffy fingers, disease-specific autoantibodies, and microvascular alterations at capillaroscopy. However, reliable biomarkers able to predict the disease evolution are missing, and decision whether to treat or not to treat in the earliest phase of the disease remains a dilemma. Presently, the only feasible clinical strategy in very early SSc remains a tight follow-up program to detect in "real time" the onset of internal organ involvement, which may thus allow an aggressive therapeutic agenda.

Propelling the Pediatric HIV Therapeutic Agenda With Science, Innovation, and Collaboration.

Background:A number of well-described obstacles to the pediatric therapeutic agenda have resulted in substantial delays in the introduction of new medications, formulations, strategies, and approaches to treat infants, children, and adolescents living with HIV.Setting:Global landscape.Methods:The authors will provide a summary of current and emerging initiatives to accelerate the pediatric therapeutic agenda including illustrative case studies of innovations and scientific discovery in diagnosis and treatment of very young children with HIV infection.Results:The challenges posed by rapid physiologic and developmental changes that characterize the trajectory of childhood as well as the complex regulatory and fiscal milieu of HIV therapeutics have hampered pediatric HIV therapeutic research. Recent efforts to accelerate this agenda include prioritizing agents and formulations, defining dosing by weight bands, applying innovative study designs, synergizing work across research networks to achieve common goals, and the establishment of a global prioritized research agenda. A case study of initiatives to diagnose and effectively treat newborns and infants will illustrate the critical role of basic science research and novel approaches to study design and implementation that are informing global efforts to end AIDS.Conclusions:A pediatric therapeutic agenda informed by basic science and achieved through innovation and global cooperation is essential to achieve an AIDS-free generation.

Very Early Systemic Sclerosis and Pre-systemic Sclerosis: Definition, Recognition, Clinical Relevance and Future Directions

The approach to systemic sclerosis (SSc) has changed over the years with an increasing focus on the very early diagnosis of the disease. The terminology identifying patients in the early phase of SSc has been significantly confusing in the last three decades. The purpose of this article is to analyze how the concept of "very early SSc" has evolved over the years, which is the role of an early diagnosis and how early treat patients. Several attempts have been made over time, to create more sensitive and specific classification criteria to include the largest number of SSc patients, also in the earliest phase. An algorythm for the very early diagnosis of SSc was identified, diagnostic preliminary criteria proposed, and new 2013 ACR/EULAR SSc classification criteria published, including new items and adding emphasis to the vasculopathic manifestations. True biomarkers that could predict the disease evolution are still missing. Treat or not to treat patients in the earliest phases still remain a dilemma. For the moment, the only feasible clinical strategy in very early SSc remains a tight follow up program to detect in "real time" the early internal organ involvement which may allow an aggressive therapeutic agenda.

Knowledge displays: Soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction

ObjectiveTo examine knowledge displays (KDs), a practice by which Therapeutic Community (TC) professionals exhibit previous knowledge about their clients’ circumstances and experiences. MethodsConversation analysis is used to examine 12 staff-led meetings recorded in Italy (8 in a drug addiction TC; 4 in a mental health TC). ResultsThe TC professionals use KDs within broader sequences of talk where they solicit their clients to share personal information and where the clients provide insufficient or inconsistent responses. In these circumstances, the staff members employ KDs to pursue responses that redress emerging knowledge gaps and discrepancies regarding the clients’ experiences or circumstances. ConclusionKDs allow the staff members to achieve a balance between respecting their clients’ right to report their own experiences and influencing the ways in which they report them. KDs help to reinforce the culture of openness that is central to many forms of therapeutic interaction, to forward the therapeutic agenda and to expand the staff members’ knowledge of the clients’ experiences and circumstances. Practice implicationsKDs can be used to solicit clients to share personal information. This paper illustrates core features that underlie the function of KDs (where they are used and how they are constructed).

Therapeutic outcomes in a museum? “You don't get them by aiming for them”. How a focus on arts participation promotes inclusion and well-being

BackgroundThe three year “Ways of Seeing” project was hosted by an award-winning museum and included adults with long-term diagnoses associated with mental health and physical impairments. The participants were involved throughout the project, preparing and curating artwork for a major public exhibition. Methods: Qualitative data were collected to explore meanings of the project from the perspective of participants, the project manager and the public, using interviews, participant observation and comment cards. Results: The project was successful in engaging the participants who had previously often felt excluded from mainstream art spaces. Findings about the benefits of arts participation echoed other studies but participants highlighted some difficulty with the ending of the project. Public perceptions were positive, acclaiming the thought-provoking quality of the exhibition. Interviews and participant observation revealed the importance of egalitarian leadership, mutual trust and the absence of any therapeutic agenda. Conclusion: Developing similar projects would offer opportunities to foster diverse artistic communities and empower people with experiences of disability and mental health conditions.

Late-Life depression and the counseling agenda: exploring geriatric logotherapy as a treatment modality

The counseling agenda established for dealing with late-life depression is often followed in consort with pharmacotherapy which has proven clinically to be quite effective in reducing and, in many cases, relieving symptoms of low self-esteem and anxiety. Whereas conventional medical intervention concentrates on the reduction of depression symptoms, psychotherapeutic modalities such as cognitive-behavioral therapy have proven somewhat effective in creating a more stabilizing experience of existential contentment, offering a deeper sense of well-being rather than simply symptom reduction. Geriatric logotherapy has come forth with an emphasis upon existential contentment drawn from accessing what is called the “life story window” wherein the therapist assists the patient in exploring the past in search of the “happy memory.” Since palliative rather than curative care is the therapeutic agenda in late-life counseling, this logotherapeutic approach has produced a treatment modality worthy of further exploration with particular attention to reminiscence and life review studies.

Intersubjective Supervision of Psychotherapy with Chronically Ill Patients

The intersubjective psychoanalytic approach offers a unique model of supervision for encouraging exploration of the mutual influences between supervisors and supervisees. The model also recommends a negotiation of the meaning of relational issues and mutual responses of supervisee and supervisor, which arise in the course of supervision. In the present article, it is argued that relational psychoanalytic supervision principles are highly suitable for clinical work with severely mentally ill patients. Intersubjective supervision may empower supervisees and develop their potential for negotiating the power structure in therapeutic dyads with chronic patients. It also encourages the exploration of individual patients’ selfhood, as expressed in their ambitions and therapeutic agenda to achieve a self-determined recovery.

Honing the stone: refining restorative justice as a vehicle for emotional redress

Commentators have frequently claimed that restorative justice (RJ) programs hold the potential to deliver therapeutic outcomes. However, if we are serious about integrating a therapeutic agenda into criminal justice, our current understanding of the mechanics of RJ is incomplete. Having established a case for doing justice better, proponents of RJ now need to think in much more concrete terms about the ways in which the process is designed in order to reap a tangible sense of forgiveness, reconciliation, and closure for victims of crime. From the evidence to date, it is suggested that there are four ‘keys’ which may be used to unlock the therapeutic potential of RJ. These are: (1) personal narratives; (2) apology; (3) forgiveness; and (4) procedural justice within restorative programs. A major challenge for future research in the area is to attempt to measure how these aspects of RJ operate at a micro-level to transform emotions.

INTERSECTIONS OF WAR TRAUMA, CULTURE, AND SOCIOANALYSIS IN MENTAL HEALTH INTERVENTION FOR POST-TRAUMATIC STRESS

<p class="Default">“Refugee war trauma” is a poor adjunct to post-traumatic stress, lacking context for a civilian survivor of war. The “therapeutic mission”, or consolidating a therapeutic agenda with political reconstitution, has its tensions: Such founders embody politics of “emotionology” (Humphrey, 2005, p. 205) bound largely to pharmaceuticals, from a land of “freedom” (where emphasis is on market) and “democracy” (where emphasis is on autonomy of choice, not accountability). Additionally, how people “cope” or “solve problems” is not universal: Therapy speaks of self-empowerment, self-actualisation, and self-control; reconciliation speaks of collective citizenship, national participation, and group reform. Instituting participation in rituals that ‘help” according to predefined norms of an American prescription to suffering speaks more to the globalisation of the American psyche (Watters, 2010; Venne, 1997) than of humanitarian relief. This paper looks at the absence of cultural and socio-political specificities within the dominant discourse on “war trauma”, that are however of ultimate relevance for people affected by war. Using a case example from my own practice with a Rwandan woman living now in Canada, I question the “helpfulness” of post-traumatic stress treatment with this instance of refugee war trauma, and the impact of power systems in mental health care. How can the therapeutic encounter, given its genesis in Eurocentric, patriarchal, enlightenment thought, pause to better consider its potential for injury, especially within contexts of post-colonial genocide? How to avoid a new “mission to civilise”? What tensions to note as the advent of “trauma counselling” seeks more global application and transnational legitimacy?</p>

Not remembering as a practical epistemic resource in couples therapy

We examine how displays of not remembering are used as an interactional resource in couples therapy. Our study contributes to the understanding of the social epistemology of memory; that is, how displays of not remembering relate to issues of knowledge and how they are assessed and understood with respect to the local interactional projects made relevant in therapy. From our analysis of transcribed audio- and video-taped couples therapy sessions, we found that clients’ displays of not remembering opened up a range of practical epistemic and rhetorical issues: 1) it enabled the creation of new ‘participation frameworks’ in which the client’s spouse could display first-hand knowledge; 2) it made relevant issues of accountability and blame for not having remembered important relationship events; 3) it indexed an avoidance or resistance of conforming to the therapeutic agenda; and 4) it deflected against the interpretation that one may have a certain interest in not remembering.

Gay Psychologists and Gay Clients: Exploring therapist disclosure of sexuality in the therapeutic closet

Therapist self-disclosure of sexuality can be therapeutically beneficial when both therapist and client identify as gay. This study attempted to explore the views and experiences of gay male clinical psychologists disclosing their sexuality to gay male clients. Five gay male clinical psychologists were interviewed, and subsequent transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). Six main themes emerged from the data: Being gay in a straight world; Disclosure and the therapeutic agenda; Contexts of disclosure; Other ways of knowing; Disclosure of sexuality: a big deal?; and The invisible curriculum. Overall, the study highlighted the participants’ thoughtfulness regarding their decisions and reasons to disclose, suggesting that disclosing their sexuality could be beneficial, but also potentially unhelpful to their gay clients. It is hoped that these findings will generate discussion and reflection, and in a small way help make gay issues more visible within clinical psychology, psychotherapy and counselling training.